1275615783 NPI number — HOT SPRINGS VETERANS ADMINISTRATION

Table of content: (NPI 1275615783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275615783 NPI number — HOT SPRINGS VETERANS ADMINISTRATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOT SPRINGS VETERANS ADMINISTRATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275615783
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12619 HOT BROOK CANYON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57747-7501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-745-5121
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 NORTH FIFTH ST
Provider Second Line Business Practice Location Address:
VA HOT SPRINGS
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-745-2000
Provider Business Practice Location Address Fax Number:
605-745-2089
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TALBERT
Authorized Official First Name:
BRADFORD
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
ADDICTION THERAPIST
Authorized Official Telephone Number:
605-745-2000

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  665 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com